Pancreatectomy Surgery

Pancreatectomy Surgery is the removal of all or part of the pancreas to treat conditions like pancreatic cancer and pancreatitis.

Some facts about Pancreatectomy Surgery:

• The pancreas is a pear shaped gland that is situated between the stomach and spine and produces digestive enzymes and hormones that regulate blood sugar.
• The removal of part or all of the pancreas is called as Pancreatectomy.
• Pancreatectomy can also be used to treat some cases of pancreatic cancer.
• The onset of pancreatic cancer in patients found to have precancerous conditions like IPMN can be prevented by using Total pancreatectomy prophylactically.
• Pancreatectomy Surgery is performed for the management of many different conditions involving the pancreas, such as benign or non cancerous pancreatic tumors, pancreatic cancer, and pancreatitis.
• The patients have to take insulin and enzyme supplement after a total pancreatectomy as the body no longer produces its own insulin or pancreatic enzymes
• The treatment of intractable pain associated with chronic pancreatitis, multicentric or extensive neuroendocrine tumors can be done by Pancreatectomy.

Preparation for Pancreatectomy Surgery:

• You must inform  about the medicines you are taking and your use of caffeine, alcohol or other drugs to your doctor before surgery as you may need to make changes to your medications or need to avoid certain substances to help healing and recovery after surgery.
• You need to quit smoking before surgery if you are smoking as it increases the risk of developing problems after surgery.
• You will receive specific instructions on how to prepare for the procedure when you schedule your surgery.
• Your hospital stay depend on your recovery.

Types of Pancreatectomy and its Procedure:

Distal Pancreatectomy and Total Pancreatectomy are the two types of Pancreatectomy. It is important to know the stage (extent) of the cancer to determine the type of surgery.
The extent of the cancer and if it can be resected can be determined by doing a Laparoscopy. A few small incisions (cuts) will be made in the abdomen by the surgeon and long, thin instruments will be inserted or this procedure. One of these instrument will have a small video camera on the end so that the surgeon can see inside the abdomen and look at the pancreas and other organs. Biopsy samples of tumors and other abnormal areas can be taken to determine how far the cancer has spread.

Distal Pancreatectomy:

The body and tail of the pancreas are removed in case of Distal Pancreatectomy. Most often the spleen is also removed. Open Distal Pancreatectomy and Splenectomy and Laparoscopic Distal Pancreatectomy are the two way that a distal pancreatectomy can be done.The pancreatic body, tail and the spleen will be removed through an open incision in a open Distal Pancreatectomy and Splenectomy. The body or tail of the pancreas will be removed through laparoscopy in a Laparoscopic Distal Pancreatectomy. Several small incisions are made through which surgical tools are placed in Laparoscopy.

Total Pancreatectomy:

The whole pancreas, part of the stomach and small intestine, common bile duct, gallbladder, spleen and lymph nodes will be removed in a Total Pancreatectomy .
Total Pancreatectomy is only recommended when disease has spread so extensively throughout the pancreas that healthy tissue cannot be preserved as the patient becomes an insulin dependent diabetic for life time after Total Pancreatectomy since the entire pancreas is removed. Total pancreatectomy can be combined with an islet cell transplant in which a transplantation of the patient's own insulin-producing cells is made in order to keep the patients from becoming diabetic. A total pancreatectomy without an islet cell transplant results in diabetic requiringinsulin for life.

Central Pancreatectomy:

The neck or body of the pancreas will be removed while preserving the healthy head and tail of the pancreas in a central pancreatectomy. The exocrine and endocrine functions of the pancreas will be preserved with working pancreatic heads and tails decreasing the chance of developing insulin-dependent diabetes.

Risks of a Pancreatectomy:

Stomach paralysis, delayed gastric emptying, Pancreatic fistula, bleeding, infection and long term digestive complications such as bowel habit changes, malabsorption, need to change your diet, diabetes, infection and weight loss are some of the risk associated with pancreatectomy.

Recovery from Pancreatectomy:

• The hospital stay for a pancreatectomy will require one to three weeks.
• Abdominal drains to drain extra fluid, Nasogastric (NG) tube to keep your stomach empty and a ladder catheter to empty urine from your bladder will be used during your hospital stay.
• You may also require epidural tube to deliver pain medications and feeding tube placed into your stomach to provide nutrition depending on your situation.
• You may also required some of these drains or tubes attached while leaving the hospital. Total parenteral nutrition, or TPN will be given. It is nutrition that is given into a vein.
• Your medical team will discuss with you the medications you will be taking for blood clot and infection prevention, and pain management before leaving the hospital.
• It is recommended to walk as much as possible, eat small frequent meals and take supplements and enzymes as directed while you are at home during the recovery period.
• Constipation can be prevented by drinking fluids and/or taking stool softeners.
• You can change your diet, drink more fluids, and take over the counter medications to manage constipation after your surgery.
• You can manage the pain associated with surgery, keep your lungs healthy after anesthesia and enhance the drainage of lymphatic fluid by taking deep breaths and resting.

Care of Incision:

• It is recommended to wear loose clothing.
• You should wash the incision very gently with soap and water and pat dry with a clean towel after that.
• It is not advisable to take tub bathe or immerse yourself in water.
• Application of any lotions, powders or ointments should be avoided unless you are told to do so by your healthcare team.